Konstantin Puchkov – Professor, MD, the leader of the Centre of Clinical and Experimental Surgery. Member of the Society of endoscopic surgeons of Russia, Member of European Association of endoscopic surgeons, the first Russian who has become Member of Association of endoscopic surgeons of Asia.

Operations for uterus prolapse

Surgical treatment of pelvic prolapse includes not only removal of disturbance of anatomic position of uterus and walls of vagina, but correction of functional disorders of adjacent organs (urinary bladder and rectum).

While performing on operation for uterus prolapse, it is necessary to achieve restoration of the structure of pelvic floor, proper positioning of organs, preserving of necessary motility of organs, creation of elastic vagina of a normal length.

Making up of a surgical program in each case implies performing on a basic operation, having the aim to create safe fixation of uterus neck and vaginal walls-it is an original author’s technique (Patent # 2015126579, RF, The Method of Laparoscopic Promontofixation ), “facilitated promontofixation” and surgical correction of present functional disturbances by vaginal access. If there is incontinence of urine in case of tension, urethropexy is added to vaginopexy. In case , if muscles of pelvic floor are weakened, we perform on colpoperineolevatoroplasty or sphincteroplasty.

It is very important!

If you are choosing operation for genital prolapse, you should use an individual approach to each patient. An individual surgical program can be compared to the set of some certain stages of operation, that are combined for each exact patient, taking into consideration her stage of disease and involvement into the pathological processes of adjacent organs. I use more than 20 stages, but I should choose 5-10 of them. That is why I should examine you, using a gynecologist’s chair, to have USI of organs of small pelvis, to have data of CUDI (complex urodynamic investigation), to have a competent conclusion of a therapeutist and only after that to discuss in detail the plan of a would-be operation.

In order to determine the stage of disease and to choose the correct surgical treatment, it is necessary to forward me (my e-mail: puchkovkv@mail.rupuchkovkv@mail.ru) the full description of USI of organs of small pelvis, and, if possible, Xerox-copy of examination of a doctor, using a gynecologist’s chair, to mention age and the main complaints. Then I will be able to give you an exact answer about your situation.

Within a hundred years this kind of operations were performed on by laparotomic and vaginal accesses, using local tissues that had their disadvantages:

operation was invasive-non-abdominal complications and complications due to the wound in case of laparotomic operation;

great number of relapses-30 %;

poor cosmetic effect and long rehabilitation.

More than 50 modifications of different operations for prolapse of pelvic organs are known. According to numerous scientific investigations displasia of the connective tissue is the cause of development of prolapse of internal genitals in more than 40% of cases. That is why the use of only local tissues for plasty promotes development of relapse of uterus prolapse in one-third of operated patients. Surgeons are in a constant search of safe ways of treatment of prolapse of uterus and vagina.

One of the most unsuccessful methods of surgical correction of genital prolapse is the use of “Prolift” system and its modifications.

During the last 20 years the method of surgical correcting prosthesis, using the contemporary mesh implants-vaginal extraperitoneal colpopexy- Gynecare Prolift System (U.S.A.) - became wide-spread.

Unfortunately, hopes have failed. The number of relapses has decreased thrice, but the whole group of dangerous complications has developed that has never been met before.

Complications related to the technique “Prolift” operation:

Perforation of cavity organs (urinary bladder, rectum) is met within the range 3-5%.

In the late postoperation period erosion of mucous membrane of vagina can develop and infectious complications (abscess and phlegmon), it is met even in leading surgeons- almost in 30 % of cases.

Later these complications require repeated operations; some patients sometimes have up to 8 operations. Even classical laparoscopic promontofixation, using contemporary soft mesh implants, in 5 % of cases promotes development of erosion of vaginal walls or infecting of prosthesis in postoperation period some time later.

All these complications are related to the fact that mesh implant is located not far from the major arterial and venous vessels, and its fixation to thin vaginal walls. Complications very often develop in females, having active sexual life. Taking into consideration all things, mentioned above, let us read the recommendation of FDA (it is the body that takes control over medical goods and food in the U.S.A.), it has been published on their site. The main conclusions are as follows:

On the basis of information about side - effects and analysis of the scientific literature, FDA has not found out the proof of the fact that the use of mesh implants in case of prolapse of pelvic organs improves the results of surgical correction as compared to traditional methods without using mesh implants. Moreover, it increases the probability of development of serious side - effects (including erosion), that can require multiple operations in future to correct side effects, but they not always correct all the problems (for example, pain) .

Sites http://sideeffectslawsuitsnews.com/ (USA) and http://www.leighday.co.uk/ (Great Britain) have published articles about the seating of the Court-of-Law, about the side-effects of mesh implants. It was mentioned there that in 2012 the sale of mesh implants was not stopped though FDA had recommended to do it. Within the period 2008-2010 about 1,200 people went to the Court-of-Law to start law-suit because complications developed in patients with “Prolift” system. It is 5 times more as compared to the period 2005-2007.

Laparoscopic
sacrovaginepoxy
mesh implant

Recommendations to medical specialists:
Placing mesh implants by vaginal access is related to great amount of complications as compared to abdominal access; efficiency of this method has not been proved as compared to plasty, using local tissues. In most cases prolapse of genitals can be corrected without use of mesh implants, and it helps to avoid complications.

Safe and efficient technique in treatment of uterus prolapse.

For many years I have been treating females with uterine prolapse. As a result of it I have elaborated the unique author’s technique (The patent # 2015126579 RF The method of Laparoscopic Promontofixation) of surgical treatment of uterine and vaginal prolapse, giving a possibility to restore natural functioning of genital function - “facilitated promontofixation” with vaginal plasty, using local tissues (colpoperineolevatoroplasty or sphincteroplasty). It is a simultaneous operation, including laparoscopic stitching of the sacral ligaments with facilitated promontofixation (fixation by an implant, involving the neck of uterus and ligaments without contact of mesh with the wall of vagina) and vaginal plasty by local tissues.

It is a high technological method of miniinvasive surgery. When using this technique of complex laparoscopic promontofixation an implant (a soft mesh) is laparoscopically placed inside for fixation of uterine neck and sacrouterine ligaments to the sacral bone. And synthetic implant mesh is located outside of vaginal walls and is covered by tissues of the body. We try to preserve uterus in case of prolapse, if there are no indications to remove uterus.

As compared to sacrovaginopexy or the use of “Prolift” technique, the implant is positioned not in the friable cellular tissue, but is placed physiologically, actually, doing “prosthesis” of weakened ligaments of uterus, restoring two of three levels of fixation of organs of small pelvis. Due to the operation of plasty of vagina and perineum by local tissues,we will restore the third physiological level of fixation of organs of small pelvis.

While performing “facilitated” promontofixation, we actively use the contemporary techniques of miniinvasive surgery, including electrosurgical instruments LigaSure, synthetic thread for stitching, anticommissural barriers.

As a result of performed operation we get cupula of vagina safely fixed in the correct vector or uterine neck with vagina and plasty of the perineum by soft tissues.

Patent. Method
for laparoscopic
promontofixation

In norm, the upper part or one-third of vagina is deviated to rectum backwards, that is why we should fix cupula in the posterior direction to the 4-th or 3-rd sacral vertebra, above the surface of levator (muscles of pelvis) and rectum. If during operation the apex of vagina is in the centre of small pelvis, then intraabdominal pressure will promote development of relapse of prolapse. During laparoscopic promontofixation we perform necessary simultaneous operation for organs of abdominal cavity and small pelvis if there are indications, but we will not be able to do it in case of vaginal access.

The technique of combined treatment of genital prolapse was created by me in 1997. I have been trying to make it perfect for 15 years. This technique has been awarded by diploma of Association of coloproctologists of Russia as the best work in the section “Laparoscopic Methods: the Use of Mesh Implant in Treatment of Pelvic Prolapse”. This technique is the most safe one and efficient in treatment of genital prolapse in females of reproductive age.

The advantages of my technique of treatment of genital prolapse:

Preserving of maximum natural anatomotopographic correlations of organs of small pelvis;

Minimizing the risk of relapse of uterine prolapse;

Minimum risk of postoperation complications (erosion of mucous membrane of vagina, dyspareunia, injury of adjacent organs, bleeding, infectious complications)-up to 0.1% as compared to use of “Prolift”;

Minimum traumas;

Improving of quality of life ( intimate relations are not restricted as in case with “Prolift” operation);

Fast period of rehabilitation (on average, the period of staying in hospital after operation does not exceed 3 days, the possibility of normal activity is preserved);

There is no need to have long hormonal preparation before operation (as compared to the classical promontofixation or placing “Prolift” system);

Possibility of simultaneous correction of other extragenital or gynecological pathology (diseases of small pelvis-myoma, adenomyosis, adhesion of tubes, ovarian cysts, etc-all of them seriously influence the female health and ability to childbirth).

The results of treatment of patients with pelvic prolapse are summarized in the monographs: “Laparoscopic Operations in Gynecology”, “Simultaneous Laparoscopic Operations in Surgery and Gynecology”, “Miniinvasive Ssurgery of Large Intestine” and in more than 20 scientific publications in different professional scientific editions in Russia and abroad. As a result of our positive experience of using this technique for many years we have got the patent # 2015126579 RF ”The Method of Laparoscopic Promontofixation//K.V.Puchkov, V.V.Korennaya, D.K.Puchkov- # 201526579/14; appl. 02.07.2015; publ.09.03.2017. Bull. 7

If you want to make an appointment with the doctor,

«When you write me letters, you should be sure that all of them will find themselves in my e-mail. I always reply your letters myself. I remember that you trust me the most precious things - your health, your fate, your family, your nearest and dearest, and I always try to do my best to justify your trust.

Every day I answer your letters, and it takes me several hours.

When you write me letters, you can be sure, that I will learn your situation very attentively, in case of need I will ask for some additional medical documents.

A great clinical experience and thousands of successful operations will give me a possibility to understand your problem even at some distance. Many patients need not surgical treatment, but properly administered conservative treatment, but some patients need urgent surgery. In both cases I would recommend additional investigations in case of need or admitting to hospital. It is important to bear in mind that some patients need preliminary treatment of accompanying diseases in order to have a successful operation.

In your letter, please, mention your age, main complaints, your place of residence, telephone number and e-mail.

For me to be able to give you a full answer, please, forward me a scanned conclusion of USI, CT, MRT alongside with your question, as well as conclusions of other specialists. After studying your case I will forward you either my detailed reply, or a letter with some additional questions to clarify the situation. Anyhow, I will try to help you and justify your hope and trust that are the most important things for me.